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How do you know if therapy is working?

Dear Alice,

I can't tell if, or when therapy is working. What are reliable signs of effective therapy?

Dear Reader,

Therapy can be extremely beneficial and even life changing, but it often takes time to work. If you're just getting started, it can be hard to tell in early stages of therapy how much progress is being made when the results aren’t so obvious. It’s also good to mention that different styles or methods of therapy vary in the length of time a person is expected to participate (i.e., some types may only last a number of weeks, while others are ongoing for years… both of which are normal depending on the specific therapy type). Additionally, effective therapy may not have the same meaning for all people, due to different goals and expectations, or for all therapeutic strategies. However, it’s probably safe to say that for most, effectiveness refers to the fact that individuals are growing and changing in regards to the concerns that brought them to seek out a therapist in the first place. Exploring your goals and expectations for therapy may help you come to a better understanding of whether it’s working for you or not.

What are some signs that therapy is effective? Learning new skills, increasing self-awareness, and reaching personal goals — all of which are common to the therapeutic process — are typically seen as signs of improvement. It also often means that you feel safe, accepted, and respected by your therapist — allowing you to be open with them about topics you’ve been thinking about on your own and would like to talk out with someone. Additionally, it’s also worth noting that, over time, another sign might be that your symptoms lessen or dissipate (e.g., feeling less depressed or less anxious).

Sometimes it can be difficult to determine whether or not therapy is effective for you, even in cases when it is in fact working. Some self-reflection may help you get to the bottom of how you feel about it. Asking yourself about your goal(s) for therapy might be a good place to start. Sometimes therapists and clients set goals together; other times, a client may come into the first session with a goal in mind. What progress do you feel you’ve made toward your goal(s)? Some other questions you may want to ask yourself include:

How about any symptoms you’re experiencing — do you feel they’ve lessened? Have they increased or worsened? It’s good to point out that some sessions may stir up emotions, or encourage you to think about something in a new way. These valuable experiences may lead to becoming more emotionally strong and healthy — even if they don’t feel great at the time (Another way to think about it might be how you feel when you exercise regularly. You may feel sore after a particularly intense session, but after a while, you become stronger).

How do you feel about the relationship with your therapist overall? Do you feel that they listen to you? Do they seem judgmental?

Do you feel like you’re on the same page with your therapist about the core issues and direction your therapy’s going?

It’s also good to consider how your expectations of therapy may impact how you feel about the process. Part of your therapist’s role is to give you hope and confidence. Research has shown that clients who start therapy with positive expectations are more likely to reach their goals compared to clients who do not have much confidence that therapy will help them. At the same time, having too high of expectations can backfire when therapy cannot live up to unrealistic expectations. The happy medium between the two is being realistic about the time and effort therapy requires while keeping a positive attitude about its potential to help.

After exploring your feelings and expectations on your own, it could be really productive for you to discuss them with your therapist. Generally speaking, therapists are typically open to discussing what’s working and what isn’t to improve the therapeutic process. Doing so can help you both get on the same page, move forward together in a new direction or with a new strategy, help you stay engaged, and feel supported throughout the therapeutic process. If after that you conclude that your current therapy isn’t working for you, remember that there are other types of therapy — and other therapists — that may be a better fit.